Cardiorespiratory arrest

TANDA DAN GEJALAo Tanda- tanda cardiac arrest menurut Diklat Ambulans Gawat Darurat

118 (2010) yaitu:

a. Ketiadaan respon; pasien tidak berespon terhadap rangsangan suara,tepukan di pundak ataupun cubitan.b. Ketiadaan pernafasan normal; tidak terdapat pernafasan normalketika jalan pernafasan dibuka.c. Tidak teraba denyut nadi di arteri besar (karotis, femoralis, radialis).

Sometimes other signs and symptoms precede sudden cardiac arrest. These may include fatigue, fainting, blackouts, dizziness, chest pain, shortness of breath, weakness, palpitations or vomiting. But sudden cardiac arrest often occurs with no warning.

Prior to cardiac arrest, some patients report the following symptoms or warning signs in the weeks before theevent:

Chest pain Weakness Pounding in the chest Feeling faint

Diagnosis

Clinical evaluation

Cardiac monitor and ECG

Sometimes testing for cause (eg, echocardiography, chest x-ray, or chest ultrasonography)

Diagnosis is by clinical findings of apnea, pulselessness, and unconsciousness. Arterial

pressure is not measurable. Pupils dilate and become unreactive to light after several

minutes.

A cardiac monitor should be applied; it may indicate ventricular fibrillation (VF),

ventricular tachycardia (VT), or asystole. Sometimes a perfusing rhythm (eg, extreme

bradycardia) is present; this rhythm may represent true pulseless electrical activity

(electromechanical dissociation) or extreme hypotension with failure to detect a pulse.

The patient is evaluated for potentially treatable causes; a useful memory aid is "Hs and Ts":

H:Hypoxia, hypovolemia, acidosis (hydrogen ion), hyperkalemia or hypokalemia, hypothermia,hypoglycemia

T:Tablet or toxin ingestion, cardiac tamponade, tension pneumothorax, thromboembolism (massive pulmonary embolus), trauma

Unfortunately, many causes are not identified during CPR. Clinical examination, chest

ultrasonography, and chest x-ray can detect tension pneumothorax. Cardiac

ultrasonography can detect cardiac contractions and recognize cardiac tamponade, extreme

hypovolemia (empty heart), right ventricular overload suggesting pulmonary embolism, and

focal wall motion abnormalities suggesting MI. Rapid bedside blood tests can detect abnormal

levels of K or glucose. History given by family or rescue personnel may suggest overdose.

DIAGNOSIS BANDINGo Heart attack (Miocardial Infark)

penatalaksanaan

o CPR

o Defibrillationo When possible, treatment of primary cause

o Postresuscitative care

Rapid intervention is essential.

CPR (see see Cardiopulmonary Resuscitation (CPR) in Adults) is an organized, sequential

response to cardiac arrest; rapid initiation of uninterrupted chest compressions ("push hard

and push fast") and early defibrillation of patients who are in VF or VT (more commonly

adults) are the keys to success.

In children, who most often have asphyxial causes of cardiac arrest, the presenting rhythm is

typically a bradyarrhythmia followed by asystole. However, about 15 to 20% of children

(particularly when sudden cardiac arrest has not been preceded by respiratory symptoms)

present with VT or VF and thus also require prompt defibrillation. The incidence of VF as the

initial recorded rhythm increases in children > 12 yr.

Primary causes must be promptly treated. If no treatable conditions are present but cardiac

motion is detected or pulses are detected by Doppler, severe circulatory shock is identified,

and IV fluid (eg, 1 L 0.9% saline, whole blood, or a combination for blood loss) is given. If

response to IV fluid is inadequate, most clinicians give one or more vasopressor drugs

(eg, norepinephrine, epinephrine, dopamine,vasopressin); however, there is no firm proof

that they improve survival.

In addition to treatment of cause, postresuscitative care typically includes methods to optimize

O2delivery, antiplatelet therapy, and therapeutic hypothermia.

PENCEGAHANo There's no sure way to know your risk of sudden cardiac arrest, so

reducing your risk is the best strategy. Steps to take include regular checkups, screening for heart disease and living a heart-healthy lifestyle with the following approaches:

Don't smoke, and use alcohol in moderation (no more than one to two drinks a day).

Eat a nutritious, balanced diet.

Stay physically active.

If you know you have heart disease or conditions that make you more vulnerable to an unhealthy heart, your doctor may recommend that you take appropriate steps to improve your health, such as taking medications for high cholesterol or carefully managing diabetes.

In some people with a known high risk of sudden cardiac arrest — such as those with a heart condition — doctors may recommend anti-arrhythmic drugs or an implantable cardioverter-defibrillator (ICD) as primary prevention.

If you have a high risk of sudden cardiac arrest, you may also wish to consider purchasing an automated external defibrillator (AED) for home use. Before purchasing one, discuss the decision with your doctor. AEDs can be expensive and aren't always covered by health insurance.

If you live with someone who is vulnerable to sudden cardiac arrest, it's important that you be trained in CPR. The American Red Cross and other organizations offer courses in CPR and defibrillator use to the public. Being trained will help not only your loved one but also those in your community. The more people who know how to respond to a cardiac emergency, the more the survival rate for sudden cardiac arrest can be improved